Discussion in 'Feline Health - (The Main Forum)' started by EllieAviles, May 18, 2017.
I would hold off on feeding him until then and go with 2 units (not 3)...
That would be a good approach Ellie. All testing will give you more pieces of his puzzle. The meter is how you learn the tune to Bear's 'sugar dance' - the more notes you hear, the better you can dance together! You've already got a good instinct.
As Nan mentioned above, you can also feed now and test in 2 hours....wet food should be worn off by then. I would want to test tonight tho' just to know more of his tune....that's just me tho'. Nice thing about this wonderful forum - you can see all sorts of opportunities and paths to take to get to the same place.
Hi, I'm so sorry you've gone through all this. When Myrtle was first diagnosed and I started reading this forum, I was concerned about being prescribed Novalin N as well. However, my cat has done really well on this insulin and looks like heading for remission - I think it's just a matter of getting the dose of insulin with the quantity of food right. It's good that you are testing now and will be able to adjust your dose accordingly.
I really think you should skip, another hypo so soon could have long term troubles. Also, hypos often kick start the pancreas into producing insulin again as well.
If it were me I'd follow the general feeding recommendation for novolin users rather than the general recommendations for lantus, they are two different insulins. The novalin has a higher kick to it following the shot. I could be wrong but I've never seen novolin users recommend waiting until the shot time to feed. Its usually stressed that feeding one hour before is very important. Your vet recommending it at shot time would scare me into getting a new vet.
I thought about the Fancy Feast, too, because he had been on the DM Diabetic food prescribed by the vet forever. I'd been wanting to switch him to soft food, but the husband was unsure until he did his own research. We never gave them bad food, but they used to have dry food down at all times. And, when one ate, they all ate, even if they weren't hungry or just ate five minutes ago.
Yeah, when I talked to the doctor she wanted me to do 4 again and I told her I wasn't comfortable with that due to his numbers and we've doubled his food intake. He used to only eat 1/2 a can twice a day. Now he's eating 1 can twice a day. I suggested 2 and then she suggested 3.
Okay... I think I'm going to hold off on meds and food until 7. I'll test and feed no mater what. If he, for some reasons, spikes super high, I'll give him 2 units, but if he stays in the range which I think he will stay in then I'm going to skip it. However, I'm going to go ahead and monitor him every 2 hours just to see how his curve is without the insulin dose and on his normal food. Just so everyone knows the game plan.
That startles me because I've always been told to feed and shoot and the same time. I'll do some research and ask them on Monday because the original directions were given when he was diagnosed and put on ProZinc, but they never changed it.
You've put my mind to ease a bit on the Novolin N, but it's still scary. Since your kitty takes Novolin N as well, could you weigh in on the feeding time? Do you feed at the same time you give the shot? If not, when do you do each and what did your own vet recommend?
Sounds like a good plan!
Definitely true! Sorry if the different voices make it confusing , but you're doing the right things to keep your kitty safe!
For the faster-acting insulins (Novalin N, Vetsulin, etc.), I know that you always always always want to make sure there is a meal "on board" before shooting, but will defer to others with more experience using those insulins on how much lead time you need.
General surfing through the vetsulin forum you encounter lots of directions to prefeed with vetsulin, For instance this thread stresses feeding at least 30 minutes before because of the quick kick the insulin has.
"Your routine should be test, then feed, wait at least 30 minutes and then administer the insulin."
Lol. It was a bit confusing, but it's been so helpful and has helped me work out my own game plan based on Bear and how he is acting.
With Prozinc, after you test and get a shootable number, it is ok to feed and immediately give insulin shot. Faster acting insulins like Novolin N, Vetsulin, Caninsulin, you want to test, feed, wait at least 20-30 minutes then give insulin shot. Hope this helps.
Agreed... definitely sounds like a good plan...
Also agree that food should be on board before shooting with faster acting insulins ... just not before testing... test, feed and shoot... it might make sense to test, feed, wait 30 minutes, then shoot... just to be safe
I vote for no shot tonight on this BG number. Start fresh tomorrow AM at a dose of 2 u. Test, feed, wait 20-30 minutes. shoot is the way to go with faster acting insulins.
Okay, I'll try that the next time he needs his shot. Thanks for the info guys.
Also, here is Bear after you all helped me through the scariest night of my life. This was around 10 AM the night/early morning of, right after the hypo. It was the first time he pulled his head up and focused on me in more than 6 hours. I'm sure he'd say thank you if he could, but I wanted to make sure you all knew how grateful I am for the support and help that night. Since I haven't said it officially, I will now. Thank you. So much!
Very handsome boy!
He's so gorgeous!
If he's above 200 but below 300 I wouldn't give more than 1 unit.
I'm glad you've upped his food intake.
Yeah. We were told 1/4 cup of food twice a day and stuck by that with the Fancy Feast as well. I'm glad we changed it, too.
Okay. I checked his sugar just a minute ago, which is 2 hours from when he should have had his shot. It was 150. I fed him 1 can of Fancy Feast Classics and am skipping his shot. I'll continue to check his sugar every 2 hours just to keep my eye open and see how he does.
* Vetsulin and 'N' (NPH) insulins start working shortly after injection - there's not a lot of 'onset' time. All of the dose works at once which is why it tends to drive numbers down steeply. There needs to be plenty of food on board for the insulin to use properly. You want to be sure kitty doesn't throw up the food before giving the shot. This is why the suggested half hour. That doesn't make them bad insulins, some cats do just fine on it. I started on NPH with my first diabetic. I've gone back to using it at times over the years of my sugarboyz' dance when other medical conditions required closer control of their bg.
* Prozinc has a bit slower and gentler onset. There is more of a 'time release' component giving it a longer cycle but it's action is also finished by the end of the cycle. This needs food available when it starts to work but it's ability to work slower gives a bit of extra time if kitty throws up food.
* Lantus and Levemir are 'depot' insulins. Their onsets are much longer and work quite differently. With those, you have usually a couple of hours to get a good meal in kitty.
The best insulin is what works best for your cat!
Oh I like your brain!
That's great information, thank you for sharing. When he was first diagnosed we tried the ProZinc (they started him at 2 units, which I'm learning is a high starting point) because they said it had a higher probability for remission. He didn't take to it at all so we switched. He finally started to show lowering numbers on the Humulin N, then we switched to Novolin N due to a drastic difference in price and the promise that they were extremely similar.
And, you like whose brain? Lol.
I just checked his levels again, two hours after eating 1 can of Fancy Feast Classic and he is at 188. He's sleeping now, but his nose is moist and he was very alert. Is this a good number with no insulin? What's the ideal number range for a cat? Does it differ if they are on insulin or off?
A well regulated diabetic cat is mostly in the Blue range (100-200) or less, A diabetic cat that stays in the Green range (50-100) without insulin is in remission, and my non- diabetic cat is 2.7-3.1 ( about 50) when I test him pre food.
Humulin N and Novolin N are the same insulin, just different manufacturers. Humulin (Eli Lilly) was Walmart's original $25 insulin, Novolin (Novo Nordisk A/S) got the contract 4-5 years ago.
Your brain silly!
Normal range on human meter is 50-120. Not to bad.
Interesting. Maybe I should check my other two boys the same time I check Bear's once in a while, just to see how they are fairing?
Do some cats run a bit high? Like, they stay in the blue range without insulin? Or do you think this could be a fallout part of his hypo episode from before?
That's good to know because I questioned the woman at the Wal-Mart pharmacy when I went to pick it up and she honestly had no idea. Her words were something like "I can't guarantee that they are the same, but you should be okay". And thank you.
My cat is in remission and is often in blue numbers... Although I use a pet meter which runs higher than human meters.
Normal on a pet meter is 68-150. Normal on a human meter is 50 to 120.
Give or take a few numbers.
You've put my mind to ease a bit on the Novolin N, but it's still scary. Since your kitty takes Novolin N as well, could you weigh in on the feeding time? Do you feed at the same time you give the shot? If not, when do you do each and what did your own vet recommend?[/QUOTE]
I test, feed and wait about 15-30 minutes to shoot. I generally test, then I let her eat, clear and wash her dish, brush her and then shoot - so I suppose that all works out to about 15 to 30 minutes later. Myrtle is very overweight so she gets 55-60g of wet food per meal (40g Royal Canin Ultralight & 15-20g something fishy - highest protein I can find). I have always shot lower than my vet recommended as I'm absolutely terrified of hypos. I don't shoot if she tests under 150. I'm fairly new to this too and Myrtle started at lower numbers than Bear but you're welcome to look at my spreadsheet of how much I shoot at different bg readings. I just looked at your spreadsheet and 4 units at a preshot test of 250 seems really excessive to me - I would probably shoot 1 - 1.5 units but I'm putting in the disclaimer that I'm not a vet, I've been doing this a short time and I don't know the cat - but that's what I would do if it were my cat.
Okay. Bear's AMPS is 260. Because yesterday's was in the 400s and after 4 units it dropped to the 100s and stayed there I think I'm going to start with 1 unit and see how he does. The vet's 4 or even 3 units feels like way too much. Thoughts?
As someone else had said... I like your brain! Sounds good!
Thank you @JohnZ I actually have a spreadsheet question.
I tested Bear at 7:00 AM and he was 260. Then I fed him. He finished around 7:30 AM. Then I waited a half hour before his shot and, just to be safe, tested him again at 8:00 AM. He read 272. The AMPS is the AM Pre Shot number, so, technically, it should be the 272, right? Should I even check him until after he's eaten? Like, in order, feed him, wait half an hour after he is done eating, check his levels, administer shot as needed? Should I even bother checking him until after he's eaten?
Sorry if that didn't make sense.
Yes... the spreadsheet AMPS should be the 272. No need to check him immediately after he eats... I would test him in a couple of hours... which you probably were planning on doing... good job!
Your preshot number is taken before food is given. So I would use the 260 number, but really there is no difference between a preshot of 260 and 272. Usually the time between preshot test and shot is a half hour. Test, feed right away, then shoot.
Me bad... didn't have my coffee yet! The spreadsheet AMPS of 260 is the correct one to record
I am going to mention again that I am not a novalin user, but there are somtimes it gets suggested to test feed and wait your 20 or 30 or 60 minutes for the food to digest, then test again before the shot to make sure the sugars are rising. This advice was given to a cat with ketone issues that desperately needed to be lower in sugar levels. The cat was also on three or four shots a day cycles to help with this and shooting rather low numbers at times.
Basically, the second test was to be sure that it wasn't a dropping bg level when the shot was given as the cat was being sort of rushed into lower sugar levels at a close to dangerous pace. So I think the answer to your question of needing a second test, is that yes it is sometimes needed. Myself, I don't know when exactly you would do this. But I would say shooting under 200, it might be a good thing to do with Novalin. but again I actually don't know.
That's essentially what I did. I tested, fed, he took a whole 30 minutes to eat all of his food, I waited 30 minutes then gave the shot. Should I not wait? Before this past incident, we had always fed then gave him his shot as he was eating.
Lol. All good. It gets confusing.
yes, with novalin you do need that waiting period.
Okay, guys. I know this thread should have ended by now, but I have another question.
If you look at his spreadsheet his AMPS was 260 so I gave him 1 unit. It gradually dropped and stayed in the high 100's for a large majority of the day. Now, his PMPS is 206. Is that too low to give another 1 unit? Since he's in the higher end of the 100's (like 170-190) should I go ahead and give him his 1 unit at 8:00 PM? Maybe decrease it to 0.5 units? The half units are harder because our needles don't have half markings.
I think if I could test, had plenty of strips, plenty of high carb food or high carb syrup; I would most likely give the 1 unit.
Also after shooting, take your syringe and practice drawing up a half unit of water and shooting it into the sink a few times. Then when you need todo 1/4 units. 1/2 units, etc it won't seem so difficult.
I do have those things. Gah, I'm just nervous.
That's a tough one... I thinking maybe give him a little less than 1 unit may be best... as long as you can test him every 2 or 3 hours... as/if necessary... the spreadsheet for today actually looks good...
I never thought I would feel happy just by seeing numbers in a blue box, but I am. Lol.
Okay. So, if we guesstimate based off of how he was today and I give him 1 unit, his lowest point should be around 116. And if I test every two hours (another long night, but worth it) and keep an eye on him, he should be okay. ... Right?
If you are worried then do 0.5-0.75
I would give 1 unit. Test at +2 to see where he's heading. If he's quite a bit lower at +2 that's a warning that you might have to intervene with carbs. The numbers today are really good and there's no big bounce going on.
Correct... or give him a "skinny" 1 unit... if he's good at +2... you could probably wait until +6 for the next test... the insulin seems to be peaking later in the cycle... although there is limited data... hope that helps...
Okay. I've gone ahead with the 1 unit. Sorry, @JohnZ , I didn't see your post in time, but I don't know what a "skinny" 1 unit is. Like you guys mentioned, I do plan to test at +2 and I'll keep a close eye on him. And yeah, these past two days, his lowest has been around +8 or +9, which is when he went hypo on the 17th as well. Is that normal?
It would be interesting to hear from experienced Novalin users about +1 tests considering its a faster acting insulin. Myself with lantus, I only really find them useful if I'm shooting a green number. I'm just wondering if a Novalin user's +1 is similar to a lantus users +2.
Each cat is different... my Derek also goes lower later in the cycle... I think most hit their low point at mid-cycle...
I'd be happy to do a +1 to see the difference if you'd like.
Thank you for letting me know.
A skinny 1 unit would have the plunger just above (with the needle pointed up) the 1 unit mark/line with no space showing.
I'm sorry, but you lost me at 'no space showing'. No space showing between the measurement line and the black part of the plunger (like the lower part of the black part)?
Yes... that's correct...
Okay. Thank you.
I'm by no means experienced, but Bear's PMPS was 206 at 7:00 PM. He ate at that time, which takes him about 30 minutes, then I gave him his shot at 8:00 PM. His +1 this time was 229.
If that were similar to a lantus +2 guideline it would suggest a typical normal cycle that might drop by 50 points around nadir(usually 5-7 for lantus).
I'm not sure if your +1 an hour after shot with a 30 minute waiting period after eating would translate to similar to a lantus user's guideline or not.
If it does suggest a normal novalin cycle. Again I am not sure what that is when your shooting a preshot of 200. My blind and uneducated guess would be a drop to around 100 at about +4 to +6 maybe. I have no idea really. Would be interesting to hear novalin users discussion about this.
From my very limited testing, it looks like Myrtle hits nadir at +5. The only time I recorded that she was around 200 at preshot I gave her 0.75 and at +5 she was 83. Although looking back another time preshot she was 220, hit 85 by +3 and then surfed for a couple of hours on that 85 - so maybe nadir is + 3 or sooner - sorry not much help....
Love, love, LOVE your new avatar, he's so handsome, looks very regal! Took a peek at his spreadsheet, he's looking good; keep up the good work!
Bear has had some very nice cycles
Numbers looking good... way to go Bear!
Thanks guys. I'm on the fence because his AMPS is 163 today. We've been doing 1 unit, even yesterday evening when he was 188 at PMPS, but it's a bit lower this time. Stick to 1 unit and test?
Have you fed yet?
I tested then fed, both at 8:30, and I normally shoot at 9:00 AM.
Maybe do something like 3/4 unit...
Or... even 1/2 unit... to be extra safe...
Once you gather more data it'll become clearer how he'll respond at these lower numbers... for now... probably better going with a lesser amount (dose)... hope that helps...
Looks like she gave 1.0U. Will you be monitoring as usual Ellie? I would try stalling next time, so if he gave you PS of 163, wait 20 minutes without feeding. If test after 20 minutes is a rising number, that can help you decide too
I've tried practicing with 0.5 units with water, as suggested, and it's extremely hard to keep it consistent on his tiny syringe. 3/4 would be impossible.
I did forget to mention his breakfast was 30 minutes late because I'm trying to slowly walk him back to his normal time.
I went ahead with 1 unit because I'm going to be home all day today with him and will, once again, being serial poking him.
Yes, I will absolutely be monitoring him all day. My issue is, his drop isn't consistent.
He's in good hands!
If you can... look into the half unit syringes... I use the Monojest's from ADW... https://www.adwdiabetes.com/product/2552/monoject-ultra-comfort-insulin-syringes
If you want to give his ears a little break, you can do mini curve tests at +3, +6, +9. Where he's at on first test will help determine how much testing you have to do
I agree... good suggestion
Thank you. And those are interesting... and MUCH better in price. We've been using the BD Insulin Syringe with the BD Ultra-Fine™ 6mm Needle.
They're expensive and the scale is very tiny and that's without the 0.5 marking (which I just learned they made. Right now he's on the very first line.
Oh! I'd never heard of that, before. I'll definitely keep that in mind. Thank you.
Also, we just bought this box of syringes and can't afford a new one right now, so I'll have to learn to adjust until we can get ones with 1/2 markins.
Walmart has Relion syringes with 1/2 unit markings and they're reasonably inexpensive.
My Walmart is still stuck in the last century so these are the only ones they carry with 1/2 unit markings; your Walmart may have them with the short needles and maybe a different gauge (larger gauge=finer needle).
My Wal-Mart pharmacy doesn't know what they're talking about most of the time. When I went to get his syringes refilled, I took his old box up (because I used to get a script sent to our other pharmacy) and asked for those or their equivalent in a different, cheaper brand. The girl brought out those, then it turned into a small discussion/debate between her and the two pharmacists of if they were the same or close enough. As long as it's a small and a short needle, it's all good, right? A unit is a unit, no matter what, right?
I used the Walmart ones for awhile... and found the markings to be wildly inconsistent ... that was a couple of years tho.
I know... I was sometimes seeing a difference of a 1/4 unit or so... from the first line to where the plunger would stop...
There was even some differences between the lines... between syringes.
There are syringes that are marked for u40 and those for u100 insulins. You want to make sure your using the correct one for your insulin. I am not sure what that is for you but for me that is a u100 syringe. So you definitely need to know whether your insulin needs u40 or u100 syringes.
I think that comment was what her pharmacist / techs trying to rationalize answering her question lol
My Walmart is like that, too. I have to be very specific about what I want, or bring in a label or box-top, because they have no clue. I have used the Monojects, I really like the fact that they glide well with no "sticking" but I have a terrible time trying to get all the air bubbles out of them - there is a small chamber between the body of the syringe and the base of the needle that always gets a bubble that I cannot get out. I have wasted A LOT of Lantus fighting with it!
Any pharmacist should know what you are talking about if you tell them you need U100, 3/10 ml insulin syringes with half-unit markings. They come in 2 different needle lengths (I personally like the shorter needle) and different gauges (I prefer 31 but my Walmart only carries 29).
@babyBoo You're absolutely correct, it is very important to know whether you need U40 or U100 syringes! She is using Novolin so she would use U100s.
Yup. It was very frustrating.
Thank you for the info!
The BD are okay, aside from no 1/2 markings, but they don't glide well when I'm measuring, causing some insulin to squirt out quickly. Is that normal?
Some brands seem to be "stickier" than others. I have the same problem with the Relion syringes.
If you kind of twist the plunger gently back and forth while you're trying to make your adjustments it sometimes helps with that stickiness.
Thanks. I'll give it a try.
Hey guys. So I was wondering what others' thoughts were on Bear's spreadsheet.
I've been having to lower his insulin bit by bit and his numbers seem to be getting lower each time, even with less insulin.
Today he was primarily in green. I actually thought the meter was messed up and tested double, sometimes triple, the amount to make sure.
Is it normal for a cat to wean off of insulin? Should I be worried or looking out for something specific?
Wow, Bear is looking amazing!!!!
Good news: getting down into the "green" numbers is going to help give his pancreas a chance to rest and (maybe) do some healing, so today was a great day for that!
Bad news: Because Novalin N is a fast-acting insulin, it can be really tricky to manage when you start getting into numbers this low. I'm not a Novalin N person so I can't be all that much help, but depending on pre-shot tonight (he may bounce, of course) I would be ready to back off the dose even more, to 0.25U or lower, in order to make sure you have more of a safety margin. The last thing you want is another hypo...
Lantus is much easier to manage at these kinds of numbers-- they have a saying on the Lantus forum "shoot low to stay low", meaning that shooting low numbers often produces gentle, flat curves keeping the cat in pancreas-healing numbers almost all day. Are you still thinking of switching over?
Yeah, I'm scared of another hypo so I've been keeping a close eye on him and his numbers. I've also been lowering his dose as needed.
Depending on how he is PMPS, I was going to cut back to 0.25 (as close as I can get with the needles) and check him at +5 or +6 since that seems to be his lowest point.
And yes, we were still wanting to switch, but, sadly, we have to wait until we financially can.
The way Bear is hustling down the dosing ladder, I'm honestly not even sure he's going to be on insulin long enough to make a switch to Lantus! Wish I could be more help in using Novalin N at this stage. On Lantus, we try to keep the cat on tiny doses of insulin as long as possible, in order to give the pancreas support, because that seems to lead to stronger remissions. With the "harsher" insulins, though, once the cat starts spending a lot of time in the green numbers I think safety concerns come in that make it more difficult to do that.
I am soooooo glad you are testing now!
Me too. I'm upset with myself that we didn't do it sooner. He has been acting much better, peeing less, and drinking less. He did just spike to 132 at +10, but it's still lower than his AM numbers yesterday and his PM numbers last night.
You are doing a fantastic job with him! It's so great when you can see the results in their behavior-- he must be feeling better too!
I can't stick around any more tonight, but I'm going to tag @JanetNJ in case she comes on tonight so she knows to check this thread and see how you're doing [side note: this thread has gotten pretty long, it'd be a good idea to start a new one soon]. She had a cat go into remission while using Vetsulin, another fast-acting insulin, so she may have some tips.
Good luck tonight-- be safe, and give Bear a skritch for being such a good boy!
Hey there! Great numbers! Good call on the 0.5 dose. Nice numbers today.
Quite a difference from a week ago, eh? Amazing. I predict it won't be long before bear is off the juice.
Next time your preshot is around 140-150 I would do a skinny 0.5.... Let a drop or two out.
120-140 do 0.25. If you can't be around to test go conservative.
Thank you. And I almost did start a new thread, but wasn't sure of the protocol.
Thank you. His PMPS was 138, just 4 points higher than his AMPS of 134, so I'm trying to decide to stick with 0.5 and check him in +5 or +6 hours or not.
I don't mind waking up to check him and, if I go by today and before, he should stick to a similar dip.
If you can test and steer then go for it.
My husband and I are hoping you're right on that, but I'm just happy he's looking and feeling better.
His PMPS was 138, so I'm still trying to decide to do .05 and check close to his lowest point, or go a bit lower.
I would hate to go lower and cause him to spike again, but in the same breath I don't want him going to low and going hypo again.
I am willing to set my alarms and wake up to test him, just to be safe, so I'm leaning more towards the 0.5 or just under based on his curve today.
I've tried practicing doing "skinny" shots with water and they're really difficult for me to do. I'm just not that talented. Lol.
Separate names with a comma.